1508155797 NPI number — METHUEN PODIATRY ASSOCIATES, LLC

Table of content: MS. PEGGY ANNE NOBLE CNA (NPI 1821566159)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508155797 NPI number — METHUEN PODIATRY ASSOCIATES, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METHUEN PODIATRY ASSOCIATES, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1508155797
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/29/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
191 BROADWAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
METHUEN
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01844-3837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-682-0382
Provider Business Mailing Address Fax Number:
978-975-3585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
191 BROADWAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
METHUEN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01844-3837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-682-0382
Provider Business Practice Location Address Fax Number:
978-975-3585
Provider Enumeration Date:
03/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KLEIN
Authorized Official First Name:
MARC
Authorized Official Middle Name:
DAVID
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
978-682-0382

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  1567 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 9756680 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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